Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used in deciding who (...) gets scarce vital organs, I remind the readers that using chronological age as a proxy is problematic as well. Using age as a proxy could give wrong results and it is better, if possible, for states to use the vital information directly than use age as a proxy. (shrink)

In this paper, I answer the following question: suppose that two individuals, C and D, have been in a long-term committed relationship, and D now has dementia, while C is competent; if D agrees to have sex with C, is it permissible for C to have sex with D? Ultimately, I defend the view that, under certain conditions, D can give valid consent to sex with C, rendering sex between them permissible. Specifically, I argue there is compelling reason to endorse (...) the following thesis: -/- Prior Consent Thesis: D, when competent, can give valid prior consent to sex with her competent partner (C) that will take place after she has dementia, assuming that D is the same person as she was when she gave prior consent, meaning that, if D, when competent, gave prior consent to sex with C, then C may permissibly have sex with D. In section I, I explain both the background and the existing literature on this issue. In section II, I outline relevant stipulations about the kinds of cases I will be examining. In section III, I defend the Prior Consent Thesis. And, in section IV, I address objections to the Prior Consent Thesis. (shrink)

My ambition in this paper is to provide an account of an unacknowledged example of blameless guilt that, I argue, merits further examination. The example is what I call carer guilt: guilt felt by nurses and family members caring for patients with palliative-care needs. Nurses and carers involved in palliative care often feel guilty about what they perceive as their failure to provide sufficient care for a patient. However, in some cases the guilty carer does not think that he has (...) the capacity to provide sufficient care; he has, in his view, done all he can. These carers cannot legitimately be blamed for failing to meet their own expectations. Yet despite acknowledging their blamelessness, they nonetheless feel guilty. My aims are threefold: first, to explicate the puzzling nature of the carer guilt phenomenon; second, to motivate the need to solve that puzzle; third, to give my own account of blameless guilt that can explain why carers feel guilty despite their blamelessness. In doing so I argue that the guilt experienced by carers is a legitimate case of guilt, and that with the right caveats it can be considered an appropriate response to the progressive deterioration of someone for whom we care. (shrink)

An exposition of ethical approaches to the elderly salient in African and East Asian philosophies and cultures, sometimes noting differences between them, while other times pointing out similarities that make them both distinct from characteristically Western approaches.

Recent disputes over whether older people should pay more for health insurance, or receive lower priority for transplantable organs, highlight broader disagreements regarding the legality of using age-based criteria in health care. These debates will likely intensify given the changing age structure of the American population and the turmoil surrounding the financing of American health care. This Article provides a comprehensive examination of the legality and normative desirability of age-based criteria. I defend a distributive justice approach to age-based criteria and (...) contrast it with two prevailing theoretical approaches to age-based criteria, nondiscrimination and discretion. I propose a detailed normative framework for the use of age-based criteria in health care, the lifetime justice approach, that considers the future life patients can gain from treatment and the past years of life they already have experienced. -/- This paper is available by open access from the Boston College Law School Digital Commons. (shrink)

It seems interesting to find out how the situation of the Polish ART practice is reflected in the medical students’ opinions. To answer this question we carried out a two-stage research adopting a data-driven methodology based upon the grounded theory, in which we collected a mixture of quantitative and qualitative data. Our study has revealed students’ high acceptance of IVF and most of the additional procedures, except for IVF in the case of women over 40 and postmenopausal ones. The students’ (...) main concerns were to be compatible with what is presented in medical literature and commonly accepted in medical practice, so the core categories they focused on in their argumentation were medical evidence and medical standards. Whereas the students were consistently trying to ground their reasoning on medical knowledge, their opinions reflected not only statements based on hard data, but also some gender stereotypes hidden in medical literature. (shrink)

Insofar as many older adults fit some definition of disability, disability studies and gerontology would seem to have common interests and goals. However, there has been little discussion between these fields. The aim of this paper is to open up the insights of disability studies as well as philosophy of disability to discussions in gerontology. In doing so, I hope to contribute to thinking about the good life in late life by more critically reflecting upon the meaning of the body, (...) ability, and the variability of each. My central argument is that we should conceptualize age‐associated bodily variations and abilities not in terms of individual capacity, but in terms of what I call “the extended body.” It is in light of the meaning of embodiment and ability in general that we must think differently and more capaciously about the meaning of late life in particular. (shrink)

Perspectives on old age are characterized by an antinomy of veneration and contempt. This paper explores how this antinomy is spelled in philosophical discourses and how it intersects with the antithesis of fool and sage. According to a Platonist or Antiochean account of ontogenesis, an individual’s development is conceived as an approximate instantiation of an ideal form of “man,” which tends to divide old people into successes and failures. In contrast to this, the Stoic theory of oikeiōsis envisages a continuous (...) process of self-constitution and self-integration that allows for continuous progress and a fundamental reorientation at any age. The elderly and ailing Stoic thus exemplifies not resignation but hope, that it is never too late to turn one’s life into a success story. (shrink)

One of the most threatening effects of dementia is the experience of forgetting or losing one’s self. How can patients and their caregivers cope with this experience? Based on the example of Arno Geiger’s narrative about his father this paper suggests aiming at a joint re-interpretation of the patient’s personality. For this purpose it is essential to respect the patient as a person with practical significance.

The effective altruism movement aims to save lives in the most cost-effective ways. In the future, technology will allow radical life extension, and anyone who survives until that time will gain potentially indefinite life extension. Fighting aging now increases the number of people who will survive until radical life extension becomes possible. We suggest a simple model, where radical life extension is achieved in 2100, the human population is 10 billion, and life expectancy is increased by simple geroprotectors like metformin (...) or nicotinamide mononucleotide by three more years on average, so an additional 750 million people survive until “immortality”. The cost of clinical trials to prove that metformin is a real geroprotector is $65 million. In this simplified case, the price of a life saved is around eight cents, 10 000 times cheaper than saving a life from malaria by providing bed nets. However, fighting aging should not be done in place of fighting existential risks, as they are complementary causes. (shrink)

Ronald Dworkin argued that Advance Directives informed by a principle of autonomy ought to guide decisions in relation to the treatment of those in care for dementia. The principle of autonomy in play presupposes a form of competence that is tied to the individual person making the Directive. This paper challenges this individualist assumption. It does so by pointing out that the competence of a patient is inherently relational, and the key illustrative case to make this point is the case (...) of music therapy. In music therapy, a relatively recent treatment modality in aged care, patients previously thought to be permanently unresponsive are shown on the contrary to be capable of significant levels of social agency. The conclusion to draw is that Advance Directives that fail to acknowledge the real possibility of such relational competence are misapplied. (shrink)

Objectives: To investigate whether different methods of obtaining informed consent affected recruitment to a study of delirium in older, medically ill hospital inpatients.Design: Open randomised study.Setting: Acute medical service for older people in an inner city teaching hospital.Participants: Patients 70 years or older admitted to the unit within three days of hospital admission randomised into two groups.Intervention: Attempted recruitment of subjects to a study of the natural history of delirium. This was done by either a formal test of capacity, followed (...) by either a request for consent or an attempt at obtaining assent from a proxy, or a combined informal capacity/consent process.Main outcome measures: Prevalence and severity of delirium, and, as case mix measures, length of hospital stay and destination on discharge.Results: Recruitment of subjects through establishing formal capacity and then informed consent was less successful and, compared with those recruited through the usual combined capacity/consent approach, yielded a sample with less cognitive impairment, lower severity of delirium, lower probability of case note diagnosis of delirium and lower rate of entering a care home.Conclusions: Methods of obtaining informed consent may significantly influence the case mix of subjects recruited to a study of delirium. Stringent testing of capacity may exclude patients with delirium from studies, thus rendering findings less generalisable. A different method is necessary to achieve an ethical balance between respecting autonomy through obtaining adequate informed consent and avoiding sample bias. (shrink)

In Western countries a considerable number of older people move to a residential home when their health declines. Institutionalization often results in increased dependence, inactivity and loss of identity or self-worth (dignity). This raises the moral question as to how older, institutionalized people can remain autonomous as far as continuing to live in line with their own values is concerned. Following Walker's meta-ethical framework on the assignment of responsibilities, we suggest that instead of directing all older people towards more autonomy (...) in terms of independence, professional caregivers should listen to the life narrative of older people and attempt to find out how their personal identity, relations and values in life can be continued in the new setting. If mutual normative expectations between caregivers and older people are not carefully negotiated, it creates tension. This tension is illustrated by the narrative of Mr Powell, a retired successful public servant now living in a residential home. The narrative describes his current life, his need for help, his independent frame of mind, and his encounters with institutional and professional policies. Mr Powell sees himself as a man who has always cared for himself and others, and who still feels that he has to fulfil certain duties in life. Mr Powell's story shows that he is not always understood well by caregivers who respond from a one-sided view of autonomy as independence. This leads to misunderstanding and an underestimation of his need to be noticed and involved in the residential community. (shrink)

Loss of self is widely regarded to be a consequence of dementia, and this perceived loss presents a variety of problems - not least because a clear understanding of the concept of self is elusive. This paper suggests a way to cut through problems that arise because we rely on conceptions of self in our understanding of the effects of dementia. It is proposed that we can avoid reliance on the concept of self through an approach based in in bio-phenomenology. (...) Such an approach would help us better understand the inner life of those with dementia and assist us to recognize that even in late stage dementia they are semiotic subjects with unique value. (shrink)

Volume Four, as indicated by the anthology's subtitle, is in honor of Simone de Beauvoir (1908-1986) and Martin Heidegger (1889-1976). The chapters do not necessarily mention Simone de Beauvoir or Martin Heidegger. The 16 chapters (by professional philosophers and other professional scholars) are directed to issues related to death, life extension, and anti-death. Most of the 400-plus pages consist of scholarship unique to this volume. Includes index. -/- -/- The titles of the 16 chapters are as follows: -/- -/- 1. (...) Mechanism, Galileo’s Animale And Heidegger’s Gestell: Reflections On The Lifelessness Of Modern Science by GiorgioBaruchello -/- -/- 2. Simone De Beauvoir by Debra Bergoffen -/- 3. Existentialism by Steven Crowell -/- -/- 4. Time Wounds All Heels by William Grey -/- -/- 5. The Ethical Importance Of Death by Jenann Ismael -/- 6. The Poetics Of Death: Intimations And Illusions by Lawrence Kimmel -/- -/- 7. Death And Aesthetics by Keith Lehrer -/- -/- 8. Ageing And Existentialism: Simone De Beauvoir And The Limits Of Freedom by Shannon M. Mussett -/- -/- 9. Life Extension And Meaning by Carol O’Brien -/- -/- 10. Consciousness As Computation: A Defense Of Strong AI Based On Quantum-State Functionalism by R. Michael Perry -/- -/- 11. Reality Shifts: On The Death And Dying Of Dr. Timothy Leary by Carol Sue Rosin -/- -/- 12. Extraterrestrial Liberty And The Great Transmutation by Charles Tandy -/- -/- 13. A Time Travel Schema And Eight Types Of Time Travel by Charles Tandy -/- -/- 14. Boredom, Experimental Ethics, And Superlongevity by Mark Walker -/- -/- 15. Exopolitics: The Death Of Death by Alfred Lambremont Webre -/- -/- 16. Embryo Cloning: Current State Of The Medical Art And Its Far-Reaching Consequences For Multiple Applications by Panayiotis M.Zavos. (shrink)

Phillips & Silverstein (P&S, 2003) have proposed that NMDA-receptor hypofunction is the central reason for impaired cognitive coordination and abnormal gestalt-like perceptual processing in schizophrenia. We suggest that this model may also be applicable to non-pathological (or normal) aging given the compelling evidence of NMDA-receptor involvement during the aging process that results in age-related change in higher-level perceptual performance. Given that such deficits are present in other neurological disorders such as autism, an argument for a systematic assessment of perceptual functioning (...) in these conditions may be posited. (shrink)